Medical payments coverage (MedPay): how it compares with PIP and health insurance

What does medical payments coverage pay for?

MedPay is first-party coverage: it pays your own side's medical bills rather than the other driver's. The Insurance Information Institute (Triple-I) describes it as paying medical expenses for covered people injured in an auto accident, such as you, your passengers and family members, no matter who is responsible. California's Department of Insurance describes it as coverage for immediate medical care regardless of fault.

Typical bills MedPay can pay include:

• Ambulance and emergency room charges.
• Hospital stays, surgery and follow-up doctor visits.
• X-rays, scans and other tests.
• Treatment for passengers who may not have health insurance of their own.

The Texas Department of Insurance adds that MedPay on a Texas policy also pays if you are hurt riding in someone else's car or while walking or biking. Policies differ on these details, so read the definitions in yours.

What MedPay does not pay for

• Lost income, household help or other non-medical costs. In states that offer it, PIP is the coverage that pays those.
• Injuries you cause to people outside your car, which are a claim against your liability coverage.
• Damage to any vehicle.
• Anything above the per-person limit you chose.

MedPay vs PIP vs health insurance

All three can pay for treatment after a crash. They differ in what else they pay, who they cover and where they apply.

How health insurance fits in

Your health plan may pay for crash injuries too, but it comes with its own deductible, copays, networks and rules on who is covered. Several states let health insurance take a bigger role in place of auto medical coverage:

• New Jersey offers a "health care primary" option that makes your health plan pay first for auto injuries. Medicare and Medicaid cannot be used for it.
• Michigan lets named insureds with qualifying health coverage choose a lower PIP medical level with exclusions, and lets those with Medicare Parts A and B opt out of PIP medical.
• Maryland lets some policyholders with health insurance waive PIP.

MedPay sits on top of these choices. It pays without regard to fault and covers passengers who may not be on your health plan. Before buying, ask your insurer how its MedPay coordinates with your health plan, and whether it pays costs your plan leaves to you, such as deductibles and copays.

States that require medical payments coverage

Many states treat MedPay as optional, but a few require it on every policy. We list only those we confirmed with the state regulator:

New Hampshire's insurance department puts it plainly: by law, any policy you buy must include at least $1,000 of MedPay, along with uninsured motorist coverage at limits equal to your liability coverage. The NAIC notes that some states require a minimum amount of coverage for your medical expenses, so check your state's rules with its insurance department or our state minimums tool.

When MedPay is worth considering

MedPay is small coverage, but it fills specific gaps. It is most useful when:

• You have no health insurance, or a plan with a high deductible.
• You often carry passengers, such as children's friends or coworkers, who may not have their own coverage.
• You live in a state without PIP, so MedPay is the only auto coverage that pays your own medical bills without waiting for a fault decision.
• You walk or cycle a lot and your policy extends MedPay to those situations.

It may add less if you already carry generous PIP, since both pay medical bills. Ask whether your insurer offers MedPay in your state, and how it works alongside PIP.

Worked example

Example: you carry $5,000 of MedPay per person. You and one passenger are hurt in a crash, and each of you has $3,000 of emergency room bills.

For example, if your bills had been $8,000 instead, MedPay would pay $5,000 and the other $3,000 would go to your health plan, PIP if you have it, or a claim against the at-fault driver.

How a MedPay claim works

Because MedPay is first-party coverage, you claim from your own insurer rather than waiting for the other driver's company to accept fault. The process is usually simple:

1. Tell your insurer about the accident promptly and say that you, or your passengers, were hurt.
2. Ask which coverages apply: MedPay, PIP, or both, and in what order.
3. Send itemized medical bills and any records the insurer asks for.
4. Keep copies of everything, including what your health plan has paid, so that bills are not paid twice.
5. If another driver caused the crash, your insurer may seek repayment from that driver's insurer. Ask how that affects any later claim you make against the other driver.

MedPay does not depend on proving who caused the crash, which can make it a quicker way to get emergency bills paid than waiting on a fault decision. Our guide to filing a claim covers the wider claim process.

How to decide whether to add MedPay

1. Check whether your state requires MedPay or PIP, and how much.
2. Read your health plan's deductible, out-of-pocket maximum and rules for car accident injuries.
3. Think about who rides with you and whether they have health coverage.
4. Ask your insurer for prices at two or three MedPay limits.
5. Ask how MedPay coordinates with your health plan and with any PIP you carry.
6. Choose a limit you would actually use: enough to cover a typical emergency visit for you and your passengers.

The coverage checklist shows where MedPay fits with the rest of your policy, including uninsured motorist coverage, which pays for injuries caused by drivers with no insurance.